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Abstract Details
Lymph node sampling in resectable hepatocellular carcinoma: national practice patterns and predictors of positive lymph nodes
Surg Oncol. 2020 Dec 30;36:138-146. doi: 10.1016/j.suronc.2020.12.011. Online ahead of print.
Phillip M Kemp Bohan1, Anne E O'Shea1, Andrew J Lee2, Robert C Chick1, Timothy E Newhook3, Hop S Tran Cao3, Casey J Allen3, Daniel W Nelson4, G Travis Clifton1, Jean-Nicolas Vauthey3, Ching-Wei D Tzeng3, Timothy J Vreeland5
Author information
1Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA.
2Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
3Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
4Department of Surgical Oncology, William Beaumont Army Medical Center, El Paso, TX, USA.
5Department of Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX, USA; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. Electronic address: vreelant@gmail.com.
Abstract
Background and objectives: Routine lymphadenectomy (LND) for resectable hepatocellular carcinoma (HCC) remains controversial. We evaluated national LND trends to identify pre-operative factors associated with node-positive disease to determine which patients might benefit from LND.
Methods: We identified HCC patients in the National Cancer Database (NCDB) treated with surgical resection between 2004 and 2015. Demographic, operative, pathologic, and survival data were compared. Multivariable regression was performed to determine preoperative predictors of pathologic nodal disease.
Results: Of 8095 total resected patients, 1442 (17.8%) underwent hepatectomy with LND. Patients who received LND had higher preoperative clinical T (T3-T4: 20.0% vs 12.1%, p < 0.001) and N (N1: 3.3% vs 0.6%, p < 0.001) stages. The strongest independent predictor of pathologic nodal disease was clinical N stage (OR 106.54, CI 44.10-257.42). Survival was highest in patients whose surgeons omitted LND or were found with LND to be node-negative on final pathology (p < 0.001). Clinical node positivity had high negative predictive value (97.9%) but moderate positive predictive value (56.3%) in estimating pathologic nodal status.
Conclusions: Defining preoperative clinical nodal status is imperative in HCC patients. Clinical node positivity was the strongest predictor of pathologic nodal disease and its associated worse prognosis. LND can be considered selectively in clinically node-positive patients.